Abstract

Background: Stress hyperglycaemia is thought to result from a hormonal response (release of catecholamines,glucocorticoids, glucagon, etc.) following stress, sepsis or trauma. Although stress hyperglycaemia is a very commonfinding in critically ill populations, there are many non-diabetic critically ill patients who do not develop a hyperglycaemicstress response to trauma or acute illness. We suggest that the lack of a hyperglycaemic stress responseduring the acute phase of a critical illness may correlate significantly with the clinical outcome of these critically illnon-diabetic patients.

Methods: This was a retrospective study of 700 non-diabetic critically ill patients admitted to the general intensivecare unit (ICU) at Soroka Medical Center, Beer Sheva, Israel. We analyzed the clinical impact of the blood glucose levelsof these patients measured during their first week of ICU hospitalization on their clinical outcome.

Results: Age, male gender, and the Acute Physiology and Chronic Health Evaluation (APACHE) score were found tobe independent risk factors for new episodes of infection during the patients’ stay in the ICU. Age and the APACHEand Sequential Organ Failure Assessment scores were found to be independent risk factors for intra-ICU mortality. Incontrast, blood glucose analysis performed during the patients’ stay in the ICU was not found to be an independentpredictor for new infectious events or for mortality during the ICU stay.

Abstract

Background: Stress hyperglycaemia is thought to result from a hormonal response (release of catecholamines,glucocorticoids, glucagon, etc.) following stress, sepsis or trauma. Although stress hyperglycaemia is a very commonfinding in critically ill populations, there are many non-diabetic critically ill patients who do not develop a hyperglycaemicstress response to trauma or acute illness. We suggest that the lack of a hyperglycaemic stress responseduring the acute phase of a critical illness may correlate significantly with the clinical outcome of these critically illnon-diabetic patients.

Methods: This was a retrospective study of 700 non-diabetic critically ill patients admitted to the general intensivecare unit (ICU) at Soroka Medical Center, Beer Sheva, Israel. We analyzed the clinical impact of the blood glucose levelsof these patients measured during their first week of ICU hospitalization on their clinical outcome.

Results: Age, male gender, and the Acute Physiology and Chronic Health Evaluation (APACHE) score were found tobe independent risk factors for new episodes of infection during the patients’ stay in the ICU. Age and the APACHEand Sequential Organ Failure Assessment scores were found to be independent risk factors for intra-ICU mortality. Incontrast, blood glucose analysis performed during the patients’ stay in the ICU was not found to be an independentpredictor for new infectious events or for mortality during the ICU stay.

Krinsley JS. Glycemic control, diabetic status, and mortality in a heterogeneous population of critically ill patients before and during the era of intensive glycemic management: six and one-half years experience at a university-affiliated community hospital. Semin Thorac Cardiovasc Surg. 2006; 18(4): 317–325.

Krinsley JS. Glycemic control, diabetic status, and mortality in a heterogeneous population of critically ill patients before and during the era of intensive glycemic management: six and one-half years experience at a university-affiliated community hospital. Semin Thorac Cardiovasc Surg. 2006; 18(4): 317–325.

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